Doctors Park Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

03726 Issued in NC

Legal business name

DOCTORS PARK PHARMACY INC

Doing business as

Doctors Park Pharmacy

Practice address

403 Western Blvd
Jacksonville, NC 28546-6870

Phone

(910) 353-5733

Fax

(910) 577-1705

NPI assigned

Nov 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly Sullivan, RPHNPI 1336626159

Title

Pharmacist and MNGR

Phone

(910) 353-5733

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• DOCTORS PARK PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Jarman Sullivan, R.PH.

  • Pharmacist
  • Jacksonville, NC
  • NPI 1336626159
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353024000000",
    "number": "1205901881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 WESTERN BLVD",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466870",
            "telephone_number": "910-353-5733",
            "fax_number": "910-577-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 WESTERN BLVD",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466870",
            "telephone_number": "910-353-5733",
            "fax_number": "910-577-1705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTORS PARK PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2012-11-16",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "PHARMACIST AND MNGR",
        "authorized_official_telephone_number": "910-353-5733",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "03726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7700938",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0675447",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3416472",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DOCTORS PARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jerry Ditz, DPT
• Heather Marie Murvin Divelbliss
• Divine Support Services, LLC.
• Shieka Dixon
• Warnell Angelo Dixon, RBT
• Doctors Park Pharmacy Inc
• Alyssa Jane Dodge, MS/CCC-SLP
• Jordan Doetsch, N.P.
• Eline Dolce
• Alyssa Donahue, OTR/L

• Community/Retail Pharmacy in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Community/Retail Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.